Turn the trauma wound into a scar. Strategic Treatment of Post Traumatic Stress Disorder (PTSD)

 "If you want to get out of it, you have to go through it"
(Robert Frost)

The Wounded Mind: Post Traumatic Stress Disorder (PTSD)

The word "trauma" comes from the Greek and means "wound". Whether it is an earthquake, a terrorist attack, an accident, an attack, anyone who experiences a trauma experiences a profound laceration between a "before" and an "after". "Before" he lived in a just and meaningful world. "After", suddenly, the world is no longer safe, nothing is more just and equitable.

Although the human being is "naturally" equipped to overcome traumatic events, it sometimes happens that those who have lived an experience of this type are unable to overcome it spontaneously and develop a Post-Traumatic Stress Disorder. A phenomenon that, unfortunately, is occurring more and more frequently in this era of terrorist attacks and natural disasters, such as the earthquake that recently devastated Central Italy.

Those suffering from Post-Traumatic Stress Disorder are continually tormented by the memory of the trauma, by a past that continues to flood and overwhelm the present with fear, pain and anger, in the form of nightmares, memories, images, sounds, smells, flashbacks, preventing the person from continuing his journey towards the future. Faced with this terrible situation, the person tries to defend himself in different ways, which we have defined "coping reactions"

- Attempt to control one's thoughts and cancel the traumatic experience
In the first place, in the illusion of being able to somehow "forget" the trauma experienced and keep the frightening sensations related to it under control, the person tries not to think about what has happened. But in doing so, he experiences the paradoxical situation whereby the more he tries to forget the more he ends up remembering more and more. In the words of Michel de Montaigne “Nothing fixes something so intensely in the memory as the desire to forget it”.

- Avoidance of situations associated with trauma
Most of those who suffer from PTSD also begin to avoid all situations related to the traumatic event, in an attempt to banish any trace of it from their memory. The effect of any avoidance, however, is to lead to a real chain of progressive avoidances until even situations or places that were once "neutral" are gradually experienced as dangerous. The final effect is not only to increase the fear that the person would like to reduce, but also to make him increasingly discouraged with respect to his own resources and increasingly limited in his life.

- Request for help, reassurance and complaints
The traumatized person often resorts to the help of others, help that can vary from the request to be accompanied in places deemed "dangerous", to that of being continually reassured, comforted or simply listened to. This strategy, which at first always effective, instead leads to the progressive worsening of the incapacity situation of the person who, by delegating to others the management of the effects of the trauma, ends up creating a real dependence and reducing his autonomy even more.

Healing the wound: overcoming the trauma with Brief Strategic Therapy

The first session with a person who has experienced trauma is crucial to the subsequent positive development of therapy. Those who have suffered trauma experience a state of emergency and a desperate need for help, yet are incapable of effecting even the slightest change on their own. The strategic therapist must therefore be able to convey to the traumatized person a strong sense of empathy ("I understand what you're feeling") and, at the same time, demonstrate the ability to be a "specialized technician" with all the tools necessary to help them. The therapist's communication and interpersonal skills, especially during the first session, are crucial to ensuring that the patient decides to "trust and rely" and is therefore willing to follow the primary approach for treating this type of disorder: the trauma novel.

Developed by Giorgio Nardone and his colleagues at the Strategic Therapy Center in Arezzo, this maneuver involves asking the patient to write down every day, in a sort of narrative and as detailed as possible, all the memories of the past trauma: images, sensations, thoughts. Each day, the patient must relive those terrible moments in writing until they feel they have written down everything that needs to be said.

Once written, he will have to avoid re-reading and put everything in an envelope. At the next session, the patient will have to hand over all his writings to the therapist. At the same time, the person is prescribed to stop talking about the trauma and how much this is still influencing his life (conspiracy of silence), conveying all the pressure of the malaise into the daily writings.

Trauma fiction is an exceptionally effective technique, as it directly addresses the primary coping reaction that maintains the disorder: the attempt to forget. This approach produces four effects : first, the person externalizes all the memories, images, and flashbacks that continually haunt them, and by transferring them to paper, they gradually begin to free themselves from them. Having to relive the trauma every day in writing also triggers a sort of "habituation" effect on the traumatic memories, which are now actively and daily sought out by the person rather than endured.

Tracing the tragic event in writing over the days also allows us to gradually detach ourselves from the fear, pain and anger that this caused, producing the ultimate effect, the temporal relocation of the past into the past. Finally, having to deliver the novel to the therapist represents a sort of "rite of passage" for overcoming the traumatic event.

Patients who agree to implement this prescription, generally already during the second session, tell how the first days of carrying out the task were really difficult and painful, but, little by little, the story became more and more "cold. ”And the memories, flashbacks and nightmares previously present daily have rapidly diminished until they disappeared.
The fact of having stopped talking about it also helped this process, allowing at the same time to free relationships with others from the weight of the past. The past put back in its place thus stops invading the person's present continuously and limiting the construction of his future.

Through the novelization of trauma, the wound of trauma gradually transforms into a scar that, while not completely disappearing, allows the person to regain their natural capacity for resilience. And so, over the course of subsequent sessions, the person begins to reclaim their life, interrupting the cycle of avoidance and gradually regaining confidence in their own resources and autonomy.

In most cases, this only maneuver maintained over time allows the person to completely free himself from the invalidating disorder; in cases where Post-Traumatic Stress Disorder has instead given rise to other types of disorders (panic disorder, various phobias, paranoia, obsessive-compulsive disorder, depression, etc.) the therapist will continue the therapy until total resolution of the problem.

The effectiveness of the strategic brief therapy model on PTSD is decidedly high, 95% of cases with an average efficiency of 7 sessions, in which 50% of cases no longer present traces of relevant symptoms after the first one. sitting.

Dr. Roberta Milanese ( Official Psychologist-Psychotherapist of the Strategic Therapy Center )

BIBLIOGRAPHY
Cagnoni F., Milanese R. (2009), Change the past. Overcoming trauma with strategic therapy, Ponte alle Grazie, Milan.
Meringolo P., Chiodini M., Nardone G. (2016), May the tears become pearls, Ponte alle Grazie, Milan.
Nardone G. (2008), Sail the sea without the knowledge of the sky, Ponte alle Grazie, Milan.
Nardone G., Portelli C. (2015), Change to know, Ponte alle Grazie, Milan.
Nardone G., Salvini A. (edited by) (2013), International Dictionary of Psychotherapy, Garzanti, Milan.